| NPI | 1013947225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 68014) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301066949) |
| 208600000X Surgery (Licence: VA 0101257291) | |
| 208600000X Surgery (Licence: NC 2015-02218) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2018-03-07 |